• Most commonly around ileocaecal valve
• Loads of Peyers patches there
• Red-current jelly stools
• Pressure => venous obstruction => engorgement => blood loss
• Pain comes from compression of the serosa of the inside bit
• Pain fibres are in the serosa
• DON'T bother doing an AXR
• Much easier, quicker to see using US
• Use AIR rather than barium enemas
• c.f. risk of perforation
• Frequency 1/300 - 1/350
• Similar to pyloric stenosis
• Secondary causes
• Meckel diverticulum
• Cancer
• Commonly B cell lymphoma, in the bowel wall
• Cysts
• Polyps
  

Circumcision

• Absolute medical indications
• Phimosis secondary to balanitis xerotica obliterans
  
• Recurrent balanoposthitis
• Relative indications
  
• Paraphimosis
• Balanoposthitis and balanitis
• Preputial “pearls” and redundant foreskin
• Phimosis
• Prevention of sexually transmitted infections?
• Uncircumcised males are more prone to genital ulcer disease (syphilis, chancroid, herpes simplex) as well as infection with human papillomavirus
• But circumcised men were more prone to urethritis
• Prevention of HIV infection
• Prevention of penile cancer
• Prevention of urinary tract infection in boys with urological abnormalities
• Trauma

Notes

• 6 month old baby, obstruction?
• Strangulated inguinal hernia (very common)
• Intussesception
• Give vitamin K to neonates
• Otherwise they'll be bleedy up to about 8 days
• If a bowel loop is wider than the vertebrae, it's distended
• Triad of obstruction
  
• Abdominal distension
• Bilious vomiting
• Not pooing
• COMMONEST CAUSE OF OBSTRUCTION IS A STRANGULATED INGUINAL HERNIA!
• NEC is a common cause of obstruction in a neonate
• Posthitis is inflammation of the foreskin